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Title: An exploration of family health assessment in community practice framed within a family nursing approach : a constructionist enquiry using comparative multi-case study
Author: O'Sullivan Burchard, Dorothee J. H.
ISNI:       0000 0004 2711 0373
Awarding Body: Glasgow Caledonian University
Current Institution: Glasgow Caledonian University
Date of Award: 2010
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At international and national level the family is recognised as an indispensable partner for promoting health, and community nurses are seen as well placed to advance family health care. Little is known about how these nurses accommodate families' needs or whether such an assessment is theoretically informed. This study aimed to gain an in-depth understanding of family health assessment, the perceptions, experiences and interactions of those involved, and the usefulness of a family-derived theoretical assessment framework. The novel integration of a symbolic interactionist and family systems perspective grounded within a constructionist methodology made it possible to arrive at a fusion of these theoretical orientations, achieved using comparative multi-case study design. Each of the four cases included a community nurse and a family. Sampling was purposeful and for maximum variation. Sequential data collection involved interviews, observations and documents that were thematically analysed. A thematic, conversation-analytical approach to speech exchanges was applied to audiorecordings of home visits. The development of an innovative, theoretically-grounded, analytical framework achieved a robust and in-depth analysis within and across cases. Triangulation and a broad inferential scheme were applied to the data. Comparison across cases extended the exploratory design and added explanatory power. There was a striking alignment in the meaning given to 'family' by both the community nurses and family members. Family health assessment was seen as an inclusive, multi-layered experience of being in the equation. The community nurses promoted solidarity by taking a family orientated approach, which involved balancing the intrusion into family life with the families' need for privacy. The families experienced the home visits as a therapeutic encounter with a trusted nurse; they did not view the visits as an assessment but rather as ongoing conversations that were highly valued for the continuity of care provided by the community nurses. Interactions between the community nurses and family members indicated that a sophisticated 'relational inquiry' had taken place. In the assessment practice of the health visitor, the community children's nurse, the family health nurse and the district nurse, conversational sequences showed four distinct circular interaction patterns from which an explanatory model of family health assessment was constructed. The community nurses' recorded case notes did not mirror the depth and breadth of the shared assessment information and the thread of relationship that was embedded in nursefamily interactions. A family-derived theoretical assessment framework helped with the mutual exploration of health needs and concerns. Key Words: family health assessment, community nurse, family nursing, constructionist methodology, multi-case study, circular interaction patterns
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available